Wednesday, November 08, 2006

Manning pushes private health care - Good respone


The following column, by Parkland Research Director Diana Gibson, was written in response to an article written last week by Preston Manning and Mark Milke advocating private health insurance. Diana's column appeared in Monday's Edmonton Journal and today's Calgary Herald. We hope you enjoy it....

'Manningcare' failed once, it will fail againCostly private insurance too expensive for some, even with subsidiesby Diana Gibson

Preston Manning identified real problems with Canada's health-care system, but his prescriptions do not hit the mark. Most notably, he, like his father Ernest Manning, favours private health insurance. Ernest Manning already tried private health insurance when he was the premier and it was a dismal failure.

In 1962, the Socreds were desperate to avoid public health insurance, which had emerged in Saskatchewan. As an alternative, premier Manning created a scheme, dubbed "Manningcare," that required individuals to buy their own health insurance, with subsidies for the poor.

A year after Manningcare was introduced, Albertans were paying the highest premiums in the country. Only the elderly, chronically ill, and those with pre-existing conditions were subsidized. But only 40 per cent of those eligible for the subsidy applied because even with the subsidy, the premiums were too high.

So, Preston Manning should be familiar with the failures of private health care. But while he points out some ailments in Canada's system -- relatively few doctors; less access to MRIs and CT scans; waiting lists for some non-emergency procedures -- his prescriptions don't address those problems.

Private health insurance is more expensive. America's private health "system" costs 50 per cent more than Canada's and delivers worse health outcomes for its population. Forty-eight million Americans have no health insurance.

More generally, a study of industrialized countries by the Organization for Economic Co-operation and Development (OECD) found private health insurance correlates with higher health spending per capita.

The study found that moving to private insurance actually increased costs for the public system in France. When looking at the Australian example, the Canadian Institute for Health Information found that adding a parallel private health insurance scheme did not even reduce public spending on health care; private premiums were so expensive that the government had to subsidize them in order to convince people to enrol.

The evidence is no better on wait lists. OECD studies reveal that shorter wait lists do not correlate with countries that have private health insurance. Creating a parallel private health system siphons doctors out of the public system, worsening wait times (doctors, as skilful as they are, cannot be two places at once). And the wait times for those 48 million Americans are infinitely long.

Manning also proposes "cost sharing" for publicly funded specialists and hospital services. "Cost sharing" is newspeak for user fees, which were shown to reduce access to health care in France and Switzerland. This reduced access results in more cases going to emergency, which adds yet more costs.

He also suggests competition in the hospital sector (code for private hospitals). Yet studies, including one recently published in the Canadian Medical Journal, show that private hospitals have worse outcomes and cost more than public ones. The Workers Compensation Board has to pay Calgary's private Health Resources Group Clinic at least 10 per cent more for the same procedures than a public hospital.

To address the real problems in the health system, we need to move away from ideological agendas like Preston Manning's and instead look to the evidence.

Spending in the most public parts of our mixed health-care system -- hospitals and staff -- has actually fallen as a portion of health spending, and is the same portion of GDP as it was in 1975. The fastest growing costs in health care are the private parts -- pharmaceuticals and for-profit health care, where costs are going through the roof.

If anything, the evidence suggests moving to a more public system, not a more private one. Alberta's public solutions to wait lists are working well. We need to invest more in hospitals, doctors, nurses and health-care staff, and waste less on private profits and shareholder dividends. Patent laws need to be changed to reduce drug costs. A national pharmacare program needs to be introduced.

Canada's public single-payer tax-funded model is the best in the world. It can be improved, but it needs re-investment after the ill-advised cuts of the '90s.

And it needs to be managed with a view to improving outcomes, rather than maximizing profits.

Diana Gibson is the research director for the Parkland Institute and co-author of The Bottom Line: The truth about private health insurance (published by NeWest press and the Parkland Institute)

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By John: Preston Manning is one of the leading members of the Fraser Institute; Extreme right wing think tank made up of US business and politial interest and Canadian Conservatives.
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